Provider Demographics
NPI:1851390959
Name:RICHMOND, DANIEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MILLBURN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1738
Mailing Address - Country:US
Mailing Address - Phone:973-258-1177
Mailing Address - Fax:973-258-1818
Practice Address - Street 1:235 MILLBURN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1738
Practice Address - Country:US
Practice Address - Phone:973-258-1177
Practice Address - Fax:973-258-1818
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061237207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG67470Medicare UPIN
NJ0700530001Medicare NSC
NJ009116Medicare ID - Type Unspecified